Under The Knife: Players often as healthy, productive as staffs create

I focus more on medical staffs in this column, but baseball is not a game that can be played in a silo, literally or figuratively. A medical staff is only as good as the players it is given, which are only as good as the players who make it through the development system, which are only as good as the players identified and drafted by the scouting system. This web of interconnectedness masks the results, but some teams are trying to integrate the process and identify the successes and failures inside their organizations. I think we should do the same, in order to try to figure out which organizations are the best at doing certain things. The first order of business is to narrow the focus. Pitching development seems to be one area that would be easy to identify the cast of characters for each team.

Let's take a look at the Red Sox, for example. Curt Young is the team's major league pitching coach. He's a well-known former player in his first year with the Sox after several years in Oakland. At Pawtucket (AAA), they have Rich Sauveur, a former pitcher and experienced minor league coach. Bob Kipper is at Portland (AA). Kevin Walker at Salem (A), and Dick Such (A) fit the same profile, though admittedly, almost all minor league pitching coaches do. There's also Ralph Truel, the minor league pitching coordinator, also a former coach. Bob Tewksbury, the former pitcher, is also notable. Tewksbury is a sports psychologist now, working at various levels of the minors and with the big club. We have to guess he has a special relationship with the pitchers, since he's the patron saint of command.

That's one team, considered both advanced and successful. While it's impossible to see philosophies or understand why they went with this group over others (aside from the fact that they're all New England natives, it appears), these are the men who deserve the credit for what goes right and the blame for what doesn't. I'll challenge team bloggers out there to take a look at your own team, adding details where possible. (One Red Sox site already does this in a way.)

Knowing this network of developers is a valuable resource. Imagine knowing that a pitcher who works with a certain coach often improves his change or that another works well with power pitchers. Information is the power and currency of fantasy sports, so we always need more. Powered by that continual quest, on to the injuries:

Nitkowski wrote a fascinating article for SI detailing his use of stem cells, bone marrow and platelet-rich plasma in order to try to make it back to the major leagues. Nitkowski isn't alone in having this procedure done, coming off the perceived success of Bartolo Colon's injection-aided comeback.

The problem, to me, is not the procedure, but the perception. Colon had chips taken out of his elbow in April of 2010. It's a procedure undergone by hundreds of pitchers and is routine enough that doctors laughingly compare it to the old game "Operation." Colon came back, as most do, was able to throw at his previous velocity, and had a year off. We have no way -- none -- of saying how much, if at all, the stem cell injection helped. Colon took longer to come back from the procedure than expected, so healing time isn't the win here.

If Nitkowski's procedure works, we'll know enough, because there will be a rush to places like Dr. Purita's in Florida or the Regenex clinic in Denver. Of greater concern is the likelihood that there are more facilities out there with even less science and lax morals. As Nitkowski details, in non-athletes, Purita normally uses hGH and IGF-1, which are banned substances in MLB. It's only going to take one clinic to bypass that ethical line ("Oh c'mon, they can't test for hGH anyway and I won't note it on your chart. You can just pay in cash.")

Nitkowski's closing line, asking why pitchers don't do this as a matter of course is both hopeful and chilling. Teams do use PRP on players, but never, as far as I can tell, as any sort of prophylactic course. Stem cells are going to be a giant issue over the next decade and this crude form is just the beginning. If nothing else, Nitkowski's article is going to start the dialogue we need so that stem cells and other genetic therapies don't pass the game by the way that performance enhancers did in the 1980s.

Many of you were asking for more details regarding Buchholz and his L2 stress fracture. The biggest question is why it was harder for a pitcher to recover from this kind of injury than it is for a position player. We have to note first that the location of the fracture is significantly different for Buchholz than David Wright, which is part and parcel of the differing demands of their respective positions. Dr. Neel Anand, one of the top back surgeons in the country, told me, "During pitching the core muscles of the back are increasingly recruited and instrumental in providing for a stable base from which increasing momentum can be generated into the shoulder and arm for pitching. This very muscular action is many a time responsible for the stress fracture, and similarly, can affect pitching if there is fracture, as there may be increasing pain." So it's the act of pitching that both caused the problem and makes it harder for a pitcher to come back. What the Red Sox have to do now, besides wait, is figure out what forces are acting on that specific location during the act of pitching. If they have to make changes, now is the time or it's just going to happen again eventually.

Strasburg is scheduled to return to game action on Sunday. He'll be at Hagerstown (A), where the owners have to love being a Nats affiliate this year. There is some concern about the start, however, as the Suns' stadium was damaged by wind and rain from a recent storm, forcing the cancellation of Friday's scheduled game. Teams are very concerned about field conditions and groundskeeping standards when it comes to rehab assignments, so sometimes you'll see an assignment change depending on where the minor league teams will be playing. (I tried calling the Suns for comment, but got lost in their maze of a voice mail system.) Strasburg is scheduled to throw an inning, though the plan is flexible enough to allow him to go one more if he breezes through the first inning on less than 10 pitches. The assignment starts the 30-day rehab clock on Strasburg, meaning he has to be back by Sept. 7, unless there's a medical setback. He could come back earlier, but for fantasy purposes, it looks like Strasburg will make three, maybe four starts in September. The ERD is reasonable, but also a reflection of the Nats schedule. Coming back on a weekend against the Mets would give him three home starts out of four, closing out the home season against the Braves. That's the smart business play. It's also worth noting that Ivan Rodriguez will start his own rehab assignment this weekend and will most likely do it at Hagerstown. (Oops, late word is that Rodriguez had a setback and may not be ready this weekend.)

Santana was checked by Mets doctors late on Thursday. The diagnosis was a bit of a fluffy one -- "shoulder fatigue." The key is that Santana didn't have significant damage, especially near the repaired area. He'll take a week off and restart his rehab work, though there was no word on how far the team thinks this will set him back. A week shut down, 10 days to dial it back up, and then a rehab start is possible, though a more conservative timeline might be used.

While we wait on that, others aren't waiting to say that Santana faces even more problems in the future. Mets Today had a long discussion, in part with sports kinesiologist Angel Borrelli, about his mechanics. My feelings about making judgments strictly from the eye are well known, but Borrelli qualifies her answers well. Santana's issues are a concern and it would be good to see the Mets (and other teams in similar situations) spend the money to get a full biomechanical analysis. It's crazy that every pitcher doesn't have this already, but in a situation where the team has $55 million on the line, it's more crazy. (Change might be coming. Three teams with spring training facilities near each other are discussing splitting the cost of setting up their own multicamera system, though there's disagreement about how to keep the information separate.)

Last week, when I briefly spoke with Rolen on the field at Great American Ballpark, I asked him how his shoulder was doing. His response was "You tell me. You probably know more about it than I do." It was something of a joke and something of a compliment. (Go for it, @Humblebrag people.) What it told me is that Rolen wasn't sure of it or himself at this stage.

As it didn't progress, the worry was that the short-term fixes like cortisone injections and similar modalities weren't cutting it any more. It's like duct-taping something together; it can only last so long before you have to do real repair work. Rolen was forced to let Dr. Tim Kremchek scope his shoulder. The surgery was a simple cleanout, removing spurs and debris. It's a positive that there was no structural repair work done, though it's possible (even probable) that this was simply skipped in order to try to give Rolen a chance to get back this season. The recovery period should be about four to six weeks, but Rolen has shown an ability to play with pain. I wouldn't be surprised to see him push back a bit quickly, knowing that he'll need more work down the line and that this could be his last chance for a playoff run. The key to look for will be when he begins swinging again.

As expected, an MRI showed that Ramirez sprained his shoulder during his fielding tumble on Tuesday. It's considered to be a relatively minor sprain, but he was out on Thursday as the team is going to be conservative with him. He's essentially day to day, but the Marlins expect him back at some point over the weekend. If you're in a daily league, you'll have to keep an eye on him, but most others can safely keep him in their lineup. As long as he does return this weekend, he'll be safe for those weekly roster sets. The short term issue is more defensive than offensive, where the bulk of fantasy value lies.)

Bedard took the mound for the Red Sox on Thursday with all the questions in the world and the expectations of a "nation" on his shoulders. More of anything on his shoulder is more than what it can usually take. If we close our eyes and ignore what we know of Bedard, his outing was at the low end of what the Sox were hoping for. It just showed more of what we know about Bedard. He's talented, has great stuff, and is inconsistent. He didn't show off fragile Thursday, which is really the one thing the Red Sox care about. If Bedard can keep doing this -- show up, take the ball, keep the team in the game -- then they'll take it.

Stairs retired from baseball this week after a career that went longer than anyone expected. He did it by being really good at one thing. He didn't look like the prototypical baseball player, but he hit like one. Pinch hitting is one of the hardest things in the game, I'm told over and over, and he did that very well. The subset of guys who can stay in the game long term doing that and being just good enough at something else tells me it's likely so. Stairs and the like help their cause by being good in the clubhouse, good with the media and other "small things" that count when it comes to all those decisions GMs make when deciding who to sign and who to keep.

One of my favorite stories in my years of doing Under The Knife came back in 2005. Stairs had left a game with a strained calf. I joked "Really? Matt Stairs has muscles?" He e-mailed me the next day with a picture of his calves, flexed. It showed the sense of humor that his teammates and coaches loved. Baseball will always need guys like Stairs and I wish him luck in whatever he does next. A lot of teams could do worse than making him a hitting instructor.

This is an important study on youth pitching. It's the overuse ... Adrian Beltre started hitting and was running more on Thursday. That's a good sign, but still no target date for a return ... Justin Morneau will start a rehab assignment this weekend, joining Rochester (AAA) on the road ... Paul Konerko played on Thursday, but the White Sox medical staff will keep a close eye on that strained calf for the next week or so ... According to Jon Heyman, the Mets will make a final decision on surgery for Ike Davis this weekend ... If you like good coffee like I do, it's well worth checking out Go Coffee Go ... Jim Thome was held out of Wednesday's game with a stiff neck. He's also three homers away from 600 and a long homestand, so it doesn't sound too serious ... Manny Acta says he expects Shin-Soo Choo to be back in the next 15 days. Things will have to speed up over the next week for that to happen, but it's quite possible ... David Freese took a ball off the helmet and will be tested for possible concussion ... Jake Arrieta doesn't have a bone spur, but a "fibrous mass" according to MLB.com's Brittany Ghiroli. She always asks the right questions about medical issues ... Dustin Mosely had shoulder surgery to help keep it from dislocating. It's not his pitching shoulder, so he should be fine for next year ... Something I never expected to hear from Bobby Jenks was that he'd done too much lifting. That's what Jenks blamed his back soreness on. He's still questionable, in so many ways ... If you didn't hear my interview with WADA's Dr. Gary Wadler, go listen now. Some of it's technical, but it's important that we get to a point where we understand what drug testing does and does not do so that we can get to a point where we either trust the testing or say it has no value. If you follow me on Twitter, you also saw a follow-up "interview" -- more of a short back and forth, limited by format -- with BALCO's Victor Conte. I'm hoping to get Victor on the podcast soon.